MEDICARE: JAMES C BOYSEN, DC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	AO5923	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	249088	OTHER	IA	MIDLAND'S
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	52781	OTHER	IA	WELLMARK
4	216156	OTHER	IA	OTHER

General Provider Information

NPI Number	:	1083898746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES C BOYSEN, DC, PC

Provider Business Mailing Address
First Line	:	1732 S WASHINGTON BLVD
Second Line	:
City	:	CAMANCHE
State	:	IA
Zip	:	52730-1713
Country	:	US
Telephone Number	:	563-259-9411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1732 S WASHINGTON BLVD
Second Line	:
City	:	CAMANCHE
State	:	IA
Zip	:	52730-1713
Country	:	US
Telephone Number	:	563-259-9411
Fax Number	:

Authorized Official
Title or Position	:	OWNER-PRESIDENT
Name	:	DR. JAMES C. BOYSEN
Credential	:	D.C., P.C.
Telephone Number	:	563-259-9411

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	07/07/2008

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